In Politics, Image Trumps Medical Reality

The mayor's prognosis looks goodmedically, anyway. Ninety-three percent of men diagnosed with prostate cancer live at least five years, and since Giuliani is relatively young and his condition was caught early, his prospects are better than most. Doctors say that whatever course of treatment he opts for would disrupt the Senate campaign only briefly; surgery to remove the prostate gland might keep him from work for about three weeks, while some forms of radiation could allow him to continue on as if nothing's happened.

Politically, the danger of diagnosis in public office has more to do with irrational expectations about our leaders' health than with such medical realities. While illness is a fact of lifeand often a manageable onethe idea of illness doesn't seem to jibe with the fanciful expectations we heap on our politicians. Today's voters like a strong, inviolable type. Thus, the taller guy always seems to end up president, despite the fact that he's as destined for the grave as the rest of us.

Typically, this seemingly unassailable leaderwho makes much of his hearty appetites and takes a few jogs with the press corpsdoesn't have his groin area mapped out in the Daily News and the Post, which both ran diagrams of the prostate gland after news of the big C broke last week. Granted, they were impersonal, Any Man drawings, the kind you might find in a biology textbook or a doctor's office. But it was hard to see them without envisioning the mayor's walnut-sized gland and surrounding parts, and no polwell, no onewants that. (The News even ran a drawing of a rectal probe used in some radiation treatments, with one bare, bent leg of a presumably nonsenatorial "patient" sketched in the background.)

A public servant does need a certain vitality to function, of course, and a candidate's ailments can sometimes be worthy of consideration. It wasn't entirely inappropriate to worry over Paul Tsongas's health in the 1992 Democratic presidential primary, for instance (though it's worth noting that he died of pneumonia rather than the lymphoma that ignited the public concern in the first place). And maybe more voters should have been paying attention to Reagan's fading brainpower, which some say was on display well before he was reelected.

But the fixation on politicians' medical specs goes beyond making sure they'll liveor think straightthrough their terms. While disabilities come by valiantly can enhance some leaders' manly charm (think Bob Dole's withered arm or Senator Bob Kerrey's wooden leg, war injuries both), watching sickness seize control of a public figure can remind constituents of their powerlessness over their own delicate innards. How else to explain the enduring horror of the Bush vomit episode, which, after all, was the result of a relatively harmless stomach flu? Watching the president throw up in the prime minister of Japan's lap brought out the bodily fear and shame in even the least squeamish of us.

Politicians past have gone to great lengths to spare the public such discomfortand avoid the dreaded appearance of weakness. In an effort to keep his cancer under wraps, surgeons removed a tumor from President Cleveland's jaw on a boat. Franklin Roosevelt did his best to conceal the effects of having had polio (a cause later picked up by the FDR memorial commission, which wanted to depict the president standing unaided, though the man had spent his entire 13 years in officeand the majority of his adult lifein a wheelchair.) And John F. Kennedy took care to make sure people didn't find out about his having Addison's disease, a hormonal disorder that causes fatigue and muscle weakness.

Keeping such things private is virtually impossible these days. Even if a reporter doesn't spot a public figure on his way into the hospital, as happened with Giuliani, few in the vote-seeking business want to risk being perceived as hiding physical problems. This is exactly what happened to poor Thomas Eagleton, the Missouri senator who was George McGovern's running mate in 1972 until it came out that he had concealed a past treatment for depression, one of the few afflictions more damaging to the image than public vomiting.

The pressure to appear both healthy and forthright may explain the regular updates on his heart that Bill Bradley felt obligated to issue during the recent Democratic presidential primary. The whole thing left the former Knick seeming defensive, never mind that the irregular heartbeat he suffers from is a relatively common and benign condition.

Illness doesn't have to stand in the way of good leadership, of course. Whatever you might think of the Elián matter, the attorney general has proven extremely skillful in not letting her Parkinson's diseaseor public fear of itinterfere with her job. Even while shaking throughout press conferences, Janet Reno has stifled unnecessary hype, telling reporters at the time of her diagnosis simply, "It doesn't bother me. And if you all will just get used to it, it won't bother you."

Alan Hevesi's experience with prostate cancer has also proven a nonissue. Though his current post as city comptroller is admittedly lower-profile than, say, Giuliani'swhose position he is planning to run for, whatever Giuliani chooses to doHevesi managed a quick triumph over a remarkably similar situation. After getting diagnosed in 1996 at an early stage, much like the mayor, he took three weeks off for surgery and recuperation and even allows that his brush with cancer may have had an upside. "I might have appreciated my job a little bit more," Hevesi said in a recent interview. "It allowed me to dive into this job and the preparation for a mayoral campaign with added vigor."

Confrontations with life-threatening disease may even enhance leadership, as Tom Duane can attest. He insists learning he was HIV-positive has made him only more committed to public life. "I will never get out of the habit of making every day count and making every fight a fight I want to win as soon as possible," says Duane, who was diagnosed in 1988. "I feel like I have to do as much as I can possibly do, this day, this week." While in office, Duane's mission has involved butting heads with Giuliani over several health issues, including the mayor's 1995 effort to dismantle the city's Department of AIDS Services. Duane says that "life and death struggle" was intimately connected to his own, more personal one.

Might Giuliani's brush with his own mortality similarly inspire or change him? Duane says he's "hoping the mayor will begin to have some more compassion for people who haven't always had the luck of the draw." Perhaps he will. In a press conference about his health, the mayor seemed refreshingly human, vulnerable even. But, if history is any guide, he will have to take care when navigating the slippery slope of public sickness. No matter how hard they seem, politicians can have a tough time surviving the perception of illnesseven if, medically, they're just fine.*